Healthcare Provider Details

I. General information

NPI: 1831565019
Provider Name (Legal Business Name): STEP UP SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5473 ODESSA ST
DENVER CO
80249-8393
US

IV. Provider business mailing address

PO BOX 390611
DENVER CO
80239-1611
US

V. Phone/Fax

Practice location:
  • Phone: 303-956-8292
  • Fax:
Mailing address:
  • Phone: 303-956-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN P JIMENEZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 303-956-8292